Improvements in diabetes processes of care and intermediate outcomes: United States, 1988-2002
Improvements in diabetes processes of care and intermediate outcomes: United States, 1988-2002
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DOI：
10.7326/0003-4819-144-7-200604040-00005
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发表时间：
2006-04-04
影响因子：
39.2
通讯作者：
Narayan, KMV
中科院分区：
文献类型：
--
作者：
Saaddine, JB;Cadwell, B;Narayan, KMV
工作背景：糖尿病护理的进展是公共卫生关注的主题。目的：通过使用标准化措施评估美国糖尿病护理质量的变化。设计：基于全国人群的连续横断面调查。设置：全国健康和营养调查（1988 - 1994年和1999-2002年）和行为危险因素监测系统（1995年和2002年）。参与者：年龄在18至75岁之间的调查参与者，他们报告了糖尿病的诊断。血糖控制、血压、低密度脂蛋白（LDL）胆固醇水平、年度胆固醇水平监测以及年度足部和散瞳眼检查，如国家糖尿病质量改善联盟措施所定义。在过去十年中，血糖控制不良的糖尿病患者比例（血红蛋白A（1c）> 9%）显示无统计学意义的下降3.9%（95% Cl，-10.4%至2.5%），而血脂控制一般或良好的人群比例（LDL胆固醇水平< 3.4 mmol/L [< 130 mg/dL]）有统计学显著性增加21.9%（Cl，12.4%至31.3%）。平均LDL胆固醇水平降低0.5 mmol/L（18.8 mg/dL）。虽然平均血红蛋白A1没有变化，但血红蛋白A1为6%至8%的人群比例从34.2%增加到47.0%。血压分布没有改变。年度血脂检测、散瞳眼检查和足部检查分别增加8.3%（Cl，4.0%至12.7%）、4.5%（Cl，0.5%至8.5%）和3.8%（Cl，-0.1%至7.7%）。报告每年接种流感疫苗和使用阿司匹林的人数比例提高了6.8个百分点（CI，2.9个百分点至10.7个百分点）和13.1个百分点（Cl，5.4个百分点至20.7个百分点）。局限性：数据均为自报，且调查没有全国糖尿病质量改善联盟的全部指标。结论：在过去的十年中，糖尿病护理过程和中间结果在全国范围内得到了改善。但是，2/5的糖尿病患者仍然有低密度脂蛋白胆固醇控制不良，1/3的人仍然有血压控制不良，1/5的人仍然有血糖控制不良。
Background: Progress of diabetes care is a subject of public health concern.Objective: To assess changes in quality of diabetes care in the United States by using standardized measures.Design: National population-based, serial cross-sectional surveys.Setting: National Health and Nutrition Examination Survey (19881994 and 1999-2002) and the Behavioral Risk Factor Surveillance System (1995 and 2002).Participants: Survey participants 18 to 75 years of age who reported a diagnosis of diabetes.Measurements: Glycemic control, blood pressure, low-density lipoprotein (LDL) cholesterol level, annual cholesterol level monitoring, and annual foot and dilated eye examination, as defined by the National Diabetes Quality Improvement Alliance measures.Results: In the past decade, the proportion of persons with diabetes with poor glycemic control (hemoglobin A(1c) > 9%) showed a non statistically significant decrease of 3.9% (95% Cl, -10.4% to 2.5%), while the proportion of persons with fair or good lipid control (LDL cholesterol level < 3.4 mmol/L [< 130 mg/dL]) had a statistically significant increase of 21.9% (Cl, 12.4% to 31.3%). Mean LDL cholesterol level decreased by 0.5 mmol/L (18.8 mg/dL). Although mean hemoglobin A, did not change, the proportion of persons with hemoglobin A, of 6% to 8% increased from 34.2% to 47.0%. The blood pressure distribution did not change. Annual lipid testing, dilated eye examination, and foot examination increased by 8.3% (Cl, 4.0% to 12.7%), 4.5% (Cl, 0.5% to 8.5%), and 3.8% (Cl, -0.1% to 7.7%), respectively. The proportion of persons reporting annual influenza vaccination and aspirin use improved by 6.8 percentage points (Cl, 2.9 percentage points to 10.7 percentage points) and 13.1 percentage points (Cl, 5.4 percentage points to 20.7 percentage points), respectively.Limitations: Data are self-reported, and the surveys do not have all National Diabetes Quality Improvement Alliance indicators.Conclusion: Diabetes processes of care and intermediate outcomes have improved nationally in the past decade. But 2 in 5 persons with diabetes still have poor LDL cholesterol control, 1 in 3 persons still has poor blood pressure control, and 1 in 5 persons still has poor glycemic control.